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In the *Suwen: Yin-Yingyingxiang Dalun* (Basic Questions: The Great Treatise on the Correspondence of Yin and Yang), Huangdi said: When dryness is excessive, it leads to dryness. Qibo further stated: The West generates Dryness; Dryness generates Metal (one of the Five Phases); Metal generates the Pungent flavor; the Pungent flavor nourishes the Lung organ. In the *Zangqi Fashi Lun* (Treatise on the Methods of Organ Qi matching the Seasons), Qibo said: The Kidney governs Winter; the Foot-Shaoyin Kidney Meridian and Foot-Taiyang Bladder Meridian govern this season; the corresponding days are Ren and Gui days. The Kidney dislikes Dryness; one should immediately consume Pungent foods to moisten it. In the *Xuanming Wuqi Pian* (Chapter on the Manifestation of the Five Qi), it is said: The Kidney abhors Dryness. In the *Tianyuanji Dalun* (Great Treatise on the Heavenly Origin), Gui Yuzhou said: The Spirit manifests as Dryness in Heaven, and as Metal on Earth. It also states: Above Yangming, Dryness Qi governs. In the *Wuyunxing Dalun* (Great Treatise on the Movement of the Five Phases), Qibo said: Dryness causes things to wither. It also states: Therefore, Wind-Cold is below, Dryness-Heat is above, Dampness is in the middle, and Fire Qi travels between them. It also says: When Dryness prevails, the earth becomes dry. In the *Jiaobi Da Dalun* (Great Treatise on the Great Changes of Qi Intersection), Qibo said: When the Yearly Metal Phase is excessive, Dryness Qi circulates widely. It also states: When the Yearly Wood Phase is deficient, Dryness Qi acts extensively. It further says: The West generates Dryness; Dryness generates Metal. Its virtue is cleanliness; its transformation is contraction and gathering; its administration is vigorous and cutting; its command is Dryness; its change is solemn killing; its disaster is the withering and falling of vegetation. In the *Wuchangzheng Dalun* (Great Treatise on the Normal Policies of the Five Phases), Qibo said: In years where Yangming rules the Heaven, Dryness Qi descends. The *I Ching* (Book of Changes) says: Among all things that dry up others, none is more blazing than Fire. It also says: Fire tends toward dryness. The *Zuo Zhuan* (Commentary of Zuo) says: Excessive indulgence in Yin [sexual excess] leads to confusion and disease. Liu Hejian, in his *Yuanbing Shi* (Original Causes of Disease), said: Wet objects become slippery when moistened, but become astringent and stagnant when dry; this is because Dryness and Dampness are opposites. For example, if the whole body feels astringent and stagnant inside and out, it belongs to the transformation of Dryness-Metal. Therefore, the autumn pulse is floating and astringent (se). Astringency means stagnation. Or numbness, which is also due to astringency. This is caused by the decline of body fluids leading to dryness and astringency. He also said: "Ku" (withered) means failing to nourish life. "He" (dried up) means having no water/fluids. "Gan" (dry) means lacking moisture. "Jin" (stiff/tough) means lacking softness. Spring and Autumn are opposite, Dryness and Dampness are different, hence the distinction. He further stated: The classics do not attribute thirst solely to Fire transformation, meaning thirst is not exclusively caused by Heat. For instance, in cases of Cold syndrome with vomiting and diarrhea, if fluids are excessively lost, dryness and thirst will also occur. Although suffering from Wind-Heat, if fluids have not yet declined, there will be no thirst. How can one only say thirst is Heat and not Cold? This disease of Dryness-Thirst often accompanies Heat, so the *I Ching* says: Among all things that dry up others, none is more blazing than Fire. Now saying thirst belongs to Dryness makes it complete. He also said: When Dryness disease is extreme, it causes irritability and thirst, counteracting via Fire transformation. The *Xuanming Fang* (Prescriptions of Xuanming) stated: Dryness and dryness belong to the root nature of Metal and Lung. The Lung stores Qi. If internal blood is damaged and Qi is deficient, allowing Wind invasion, the skin will crack and peel. Wind overcomes Dampness, Heat consumes fluids; both can cause Dryness. Thus, the classics say: Wind, Heat, and Fire jointly belong to Yang; Cold, Dampness, and Dryness jointly belong to Yin. Moreover, Dryness and Dampness are distinct. Although Dryness-Metal belongs to Autumn Yin, its nature differs from Cold-Dampness; Dryness Yin is superior to Wind-Heat-Fire. Therefore, when Wind-Heat is severe, Cold-Dampness aligns with Dryness. However, Middle-Jiao Cold with vomiting and diarrhea, leading to fluid loss and Dryness, is also due to this. Thus, the classics say: All astringency, withering, drying up, stiffness, and skin cracking belong to Dryness. Zhang Zihe said: Dryness outside causes skin cracking; Dryness inside causes withering of essence and blood; Dryness above causes scorching dryness of throat and nose; Dryness below causes constipation and urinary retention. This Dryness as a disease is the transformation of Yangming. *Danxi Xinfa*: Xiao Ke (Wasting-Thirst) and stool constipation are listed in the Dryness section. (Xiao Ke and stool constipation are detailed elsewhere in this book, omitted here.) Wang Kentang said: Dryness is Yangming Dryness-Metal, the Qi of the Lung and Large Intestine. Diseases of Dryness all belong to the transformation of Dryness-Metal, yet what makes Metal dry is Fire. Hence it is said: Among all things that dry up others, none is more blazing than Fire. Metal is the master of Yin and the source of Water. Receiving Dryness Qi, if the source of Cold-Water exhausts above and cannot irrigate the body or nourish the bones, resulting in dry complexion and lack of lustrous skin and hair growth, there is a reason. Yu Jiayan said: Injury by Wind in Spring, Summerheat in Summer, Dampness in Late Summer, Dryness in Autumn, and Cold in Winter. I feel the principle of matching the Six Qi to the Four Seasons does not contradict the Five Movements, resolving a millennium-old doubt. Then how can Autumn Dryness be ignored? Autumn does not suddenly become dry. After intense heat, coolness arises; as coolness increases and heat dissipates, gradually reaching great coolness, the Dryness command then operates. He also said: In the Pathogenesis, all Qi stagnation and depression belong to the Lung. All Wei, wheezing, and coughing belong to the Upper Jiao. These two points clearly refer to Dryness diseases. The *Shengqi Tongtian Lun* (Treatise on Life Energy Connecting to Heaven) states: Autumn injury by Dryness causes upward rebellion and cough, developing into Wei Jue (impotence/weakness). The essence of Dryness disease is summarized in one sentence, consistent with the two pathogenesis points, except for the mis-transmission of injuring Dryness as injuring Dampness. Jiang Baosu said: Dryness syndromes are those of the Metal Dryness among the Six Exogenous Pathogens, differing from the Dryness of Fire syndromes. Fire Qi is fierce, scorching Yin and consuming fluids, present in many diseases. Each should be treated according to its own section, not entering the Six Exogenous Dryness section. Dryness-Metal syndromes had no severe diseases in the *Neijing*; in the Five Movements and Six Qi, they merely speak of overcoming and retaliating Qi. Predecessors mistakenly identified Fire Dryness as Metal Dryness. *Suwen: Yin-Yingxiang Dalun* says: The West generates Dryness; Dryness generates Metal. *Tianyuanji Dalun* says: The Spirit is Dryness in Heaven, Metal on Earth. It also says: Above Yangming, Dryness Qi governs. *Jiaobi Da Dalun* says: When Yearly Metal is excessive, Dryness Qi circulates. *Wuchangzheng Dalun* says: When Yangming rules Heaven, Dryness Qi descends. *Zhizhen Yao Dalun* says: When Yangming rules Heaven, its transformation is Dryness. These Neijing chapters discuss Metal Dryness. The *I Ching* says: Drying up all things... and Fire tends toward dryness. This refers to the fierceness of Fire Qi. Fire dries things that are not yet dry and tends toward things already dry; this is Fire. Things that dry themselves without waiting for Fire, which Fire cannot tend toward, are Metal. (Lanting notes: Testing items under a lamp, Fire tends toward the dryness of all items. Only Metal's dryness, Fire does not tend toward. If Metal is above and Fire below, it is Fire melting Metal, not Fire tending toward Metal.) Metal only dries itself, it cannot dry other things; Fire not only dries but can dry all things. All things can be wetted, but Metal cannot be wetted. This is why Metal Dryness differs from the dryness of other things. Fire Qi can dry, Wind can dry, Cold can dry, but none compare to the inherent capability of Metal Dryness. Try putting all things and Metal into water; only Metal does not become wet. (Xianghai notes: Jade and stone also do not become wet, as metal and stone are of the same category. Li Shizhen said: The essence of stone is Metal and Jade.) Put them into fire; only Metal does not wither. This reveals the true nature of Metal Dryness; how can it be confused with Fire Dryness? Predecessors did not know Metal Dryness inherently lacks severe disease; seeing Fire's fierceness in many diseases, they mistakenly placed Fire Dryness into the Metal Dryness category. They failed to examine the principles of the *Neijing* and *I Ching*. Metal in Qi is Heaven, vast and bright, unchanging. In substance, it is Metal, strong and pure, enduring forever. In position, it is West, East produces, West completes. In time, it is Autumn, Spring flowers, Autumn fruits. In disease, it is limited to ailments like pale hair and falling leaves, like autumn leaves dropping while roots and essence remain stored within. This shows Metal Qi achieves success; Dryness is not a severe disease. Thus, the *Neijing* chapters attribute Autumn illness to Dampness, not Dryness, for this reason. Liu Hejian equated thirst with Dryness (This is Fire drying Metal, not Metal self-drying). He also equated internal blood damage with Dryness (This is Fire scorching, Yin declining and fluids depleting, not caused by Metal Dryness). Zhang Zihe equated scorching dryness of throat/nose and constipation with Dryness disease (This is Fire flaming upward and burning downward, not Metal Dryness). Zhu Danxi listed Xiao Ke and constipation in the Dryness section (Xianghai notes: These are all Fire Dryness, not Metal Dryness. Some ask: Drinking much and urinating much, yin constipation, isn't this Metal Dryness? Answer: Frequent urination means interior is not dry; yin constipation is Fire deficiency, representing the cold dryness of frozen water and cracked earth). Wang Kentang said what makes Metal dry is Fire (My nephew Anbo said: The dryness of all things awaits Fire. Only Metal Dryness does not await Fire; burning Metal melts it into liquid, removing the dry appearance). Yu Jiayan cited Autumn injury by Dryness, claiming the *Shengqi Tongtian Lun*'s "Autumn injury by Dampness" was a mis-transmission of injuring Dryness as Dampness, and arbitrarily cited Qi stagnation, Wei, wheezing, and vomiting as Dryness syndromes (Lanting notes: The *Neijing* does not say Autumn injury by Dryness, but by Dampness. Considering Five Phases, Five Directions, and Five Positions: East-Spring-Liver-Wood generates South-Summer-Heart-Fire; South-Summer-Heart-Fire generates Central-Late Summer-Spleen-Earth; Central-Late Summer-Spleen-Earth generates West-Autumn-Lung-Metal; West-Autumn-Lung-Metal generates North-Winter-Kidney-Water; North-Winter-Kidney-Water regenerates East-Spring-Liver-Wood. The cycle is endless. Spleen Earth has no fixed position but thrives in the four seasons, governing Central Late Summer, generated by South Heart Fire, generating West Lung Metal. Thus Spleen Earth moves from South to Center, Center to West, thriving at the end of Summer and beginning of Autumn, hence called Late Summer. Metal Dryness is not a severe disease; Dampness is also an Autumn pathogen, capable of lying dormant and manifesting later, hence "Autumn injury by Dampness, Winter generates cough." Yu Jiayan was eloquent but prone to exaggeration, unaware of the subtleties of Metal Dryness. He erroneously claimed Autumn Dryness injures the Lung, stating the *Neijing*'s "Autumn injury by Dampness" was a mis-transmission of injuring Dryness as Dampness, and absurdly altered the text, requiring refutation.) None understood the inherent nature of Metal Dryness in the *Neijing*. Autumn Metal Qi, though appearing dry externally, generates Water, and Metal-Water is stored internally; how can there be internal dryness? Like Water thriving in Winter, yet Winter water easily drying up because it is stored internally. How can one say Water dries up in Winter? This is why Metal Dryness is not a severe disease: external dryness but internal non-withering. The internal and external dryness in diseases is Fire. Since Hejian, all discussions of Dryness syndromes by sages were Fire Dryness, not Metal Dryness, and should not enter the Six Exogenous Dryness section. Now establishing the Dryness section to correct the names of the Six Exogenous Pathogens. Briefly: In Heaven it is Qi, on Earth it forms shape. In Heaven it is Dryness, on Earth it becomes Metal. Metal stops at dryness; dry but not withered, thus disease is mild. Fire does not stop at dryness; dryness leads to withering and burning, thus disease is severe. Therefore, the *Neijing* has Fire Dryness but no Metal Dryness syndrome. Later baseless remarks are unreliable.

Formulas for Fire Syndromes: Yuhu Dan (25); Xue Lizhai's Modified Bawei Wan (26).

Latent Pathogen Chapter 8: *Chuntian Yihua* states: Xiaojin Dan treats the preemptive resolution of latent pathogenic warm epidemics. After war and famine, people often suffer epidemics, which depends on human affairs rather than heavenly timing. Yet cattle get plague while humans do not; chickens get pestilence while ducks do not. Is this not heaven? It seems when both heavenly timing and human affairs fail, epidemics arise. Cinnabar (5 qian), Realgar (5 qian), Black Agarwood (5 qian), Tsao-ko Kernel (5 qian), Magnolia Bark (1 liang), Betel Nut (1.5 liang), White Sandalwood (1 liang), Dalbergia Odorifera (1 liang), Rhubarb (1.5 liang). Grind into powder, bind with Fermented Rice Pill paste, make pills the size of tung tree seeds, coat with gold foil. During epidemic outbreaks, take 1 qian on an empty stomach with boiled water, and 3 pills after each meal. Pills can also be thrown into wells or water vats, any amount is effective. Also treats mountain miasma, malaria, sand demons, cholera, and evil spirits.

Chaihu Shengdi Tang: Treats latent pathogenic warm epidemics where the patient is weak but the pathogen is strong, righteous Qi cannot overcome evil, making attack and tonification difficult, or improper use leads to prolonged unresolved illness, residual pathogens remain, Yin fluids severely depleted, pathogen and righteous Qi stalemate, nearing death. Raw Rehmannia Root (4-8 qian), Bupleurum Root (1 qian), Scutellaria Root (1.5 qian), Prepared Licorice Root (0.5 qian), Angelica Sinensis Body (3 qian), Red Peony Root (2 qian), Poria (3 qian), Tangerine Peel (1 qian), Fresh Reed Rhizome (2 liang). For severe weakness add Ginseng (1 qian); for constipation add Achyranthes Bidentata (3 qian); for poor digestion add Millet Sprout and Fermented Rice Pill.

Chaihu Baitu Tang: Treats latent pathogenic warm epidemics with fever, floating pulse, sweating, irritability, and thirst, unsuitable for Notopterygium and Saposhnikovia. Bupleurum Root (1 qian), Scutellaria Root (1.5 qian), Angelica Sinensis Body (2 qian), Prepared Licorice Root (0.5 qian), Raw Gypsum (8 qian), Anemarrhena Rhizome (2 qian), Light Bamboo Leaf (30 slices), Rice (5 qian). For excess phlegm add Processed Pinellia Ternata (1.5 qian) and Tangerine Peel (1 qian). For fullness below the heart add Aurantium Fructus (1 qian) and Platycodon Root (1 qian), or add Autumn Pear (2 liang) or Water Chestnut (6 pieces).

Renshen Dahuang Tang: Treats latent pathogenic warm epidemics where purgatives were delayed for too long, Yin fluids are withered, consciousness is dull, urine is red and turbid, stool is retained, appetite is absent, limbs tremble, body emaciated, pulse is faint. Attack fails to sustain Yuan Qi; tonification fails to resolve pathogen binding. Both attack and tonification are futile; better to decide than wait passively. Hence this formula is established for a slim chance. Raw Rhubarb (3-5 qian, or 8 qian), Ginseng (1-1.5 qian, or 3 qian). Decoct these two separately in flowing water and mix before taking.

Zhong Chengqi Tang: Treats all purgative indications for latent pathogens. Worrying that Dachengqi Tang is too harsh, Xiaochengqi Tang too mild, Tiaowei Chengqi Tang too slow, and San Yi Chengqi Tang too complex, it holds the middle ground. Raw Rhubarb (3 qian), Mirabilite (2 qian), Immature Bitter Orange (1 qian).

Loubei Erchen Tang: Treats interior excess requiring purgation, where the patient is weak but the pathogen is strong, unsuitable for Mirabilite and Rhubarb. Trichosanthes Seed (4 qian), large Fritillaria Bulb (2 qian), Red Poria (3 qian), Raw Licorice Root (0.5 qian), Processed Pinellia Ternata (1.5 qian), Tangerine Peel (1 qian), Bran-fried Immature Bitter Orange (1 qian), Fresh Reed Rhizome (2 liang). Optionally add Light Bamboo Shavings (1.5 qian), large Water Chestnut (6 pieces), aged dried tangerine peel (2 liang), or Gaotan Wan (3 qian).

The general method for treating epidemics involves sweating, purging, and nourishing Yin. However, purgative indications account for 80-90%. Purging correctly ensures success; incorrectly, danger and death follow immediately. The subtlety lies in the mind. Here are briefly listed the indications for purging, for skilled practitioners. Tongue coating prickly, black, gray, yellow, or white; tongue stiff, hard, short, cracked, or curled. Lips and teeth scorched black. Nose coal-like as if smoked. Eyes red as if scorched. Throat dry craving cold drinks. Fullness, distension, pain, and refusal to press from chest to lower abdomen. Urine red and turbid, or painful drops. Diarrhea of pure foul-smelling water or like spoiled sauce. Severe constipation. Both stool and urine blocked. Heat Jue (cold extremities), deeper Jue means deeper heat, even cold body and hidden pulse. Coma like drunkenness. Mania. Wasting-thirst. Delirious speech and irritability. Convulsions with rigid body. Tidal fever at Wei/Shen hours (1-5 PM). Hiccups, abdominal fullness, inability to pass stool/urine. Jaundice. Blood stasis. Generally suitable to purge using Xijiao Dihuang Tang combined with Tiaowei Chengqi Tang. For those constitutionally Yang-deficient, add Processed Aconite Root. For extreme Yin deficiency, decoct medicine with Raw Rehmannia Dew. For Qi deficiency, add Ginseng. For excess phlegm, add aged Pinellia with Alum. Do not wait seven days for purging; some die in three to five days. With these signs, administer these medicines. Most dying in three to five days have purgative indications. However, there are contraindications: after severe labor or sexual excess, pre-existing deficiency, advanced age with declining Qi, weak constitution, or sudden latent pathogen emergence, like an empty city facing enemies, where fighting or defending is difficult. Use Xijiao Dihuang Tang combined with Shengmai San, hoping for survival.

*Rites of Zhou - Heavenly Officials*, Physician Department: Physicians manage the diseases of the myriad people; there are epidemic diseases in all four seasons.

*Lüshi Chunqiu - Mengchun Ji*: In early spring, if autumn measures are taken, the people will suffer major epidemics. In late spring, if summer measures are taken, the people will suffer many epidemics, seasonal rains will not fall, and hills will not yield harvest. In midsummer, if autumn measures are taken, grass and trees will wither, fruits will ripen early, and people will suffer epidemics. In midwinter, if storehouses are opened and large tombs dug, earth Qi will leak, called opening heaven's granary; hibernating insects will die, and people will suffer many epidemics.

*Liji - Yueling*: In early summer, if autumn measures are taken, the people will suffer major epidemics.

*Records of the Grand Historian - Biographical Sketches of Bian Que and Cang Gong*: Chang Xin, Director of the Qi Imperial Carriage Office, fell ill. Cang Gong examined his pulse and said: This is Heat Qi disease. However, sweating in summer with a slightly weakened pulse indicates survival. He said: This illness resulted from bathing in running water while very cold, followed by heat. Chang Xin agreed: Yes. Last winter, while serving as an envoy to Chu, he reached Yangzhou River in Juxian County. The bridge was broken. Chang Xin held the carriage shaft, unwilling to cross. The horse panicked and fell; Chang Xin entered the water, nearly drowning. Officials rescued him. His clothes were soaked. Soon he felt cold, then hot as fire, unable to tolerate cold since. Cang Gong prepared a decoction and fire agent to drive out heat. After one drink, sweat ceased; after two, heat gone; after three, disease cured. Even after twenty days of medication, he remained healthy. Knowing Chang Xin's illness, Cang Gong noted the pulse showed concurrent Yin. The *Pulse Classics* state: Death occurs in Heat diseases when Yin and Yang intersect. Here, they did not intersect; concurrent Yin means the pulse is smooth and clear, indicating recovery. Though heat remains, he lives. Kidney Qi occasionally turbid at the Taiyin pulse point indicates Water Qi. The Kidney governs Water, hence known. Delayed treatment for a moment turns it into alternating chills and fever.

*Shuowen*: Yi (Epidemic) means all people are sick.

*Shiming*: Yi means service/campaign. It implies ghosts performing a campaign.

*Zhang Hua's Bowuzhi*: During Emperor Wu of Han's reign, the Yuezhi Kingdom of the Western Regions crossed the Ruo River to tribute three pieces of Resurrection Incense, size of swallow eggs, black like mulberries. At that time, a major epidemic struck Chang'an. The Western envoy requested burning one piece to ward it off. Sick people in the palace heard the scent and recovered; the scent spread a hundred li, lasting several days. Those dead from epidemic for less than three days revived upon fumigation. (Logically impossible, but events may occur. Fragrant aromatics indeed resolve epidemics.)

*Zizhi Tongjian - Tang Annals*: Guanzhong suffered consecutive years of famine. Soldiers and civilians were thin and dark. Wheat finally ripened. Drunkards appeared in the market, considered an auspicious omen. People ate suddenly until full; one-fifth died.

*Taiping Yulan*, Vol. 742, cites Cao Zhi's *Shuo Yi Qi*: In the 22nd year of Jian'an, lethal Qi circulated. Every family mourned corpses; every room wept. Some entire households perished; some clans were wiped out. Some believed epidemics were caused by ghosts and gods. Those afflicted were mostly sons of coarse cloth and wild vegetable eaters, living in thorn-hedged and thatched houses. Those in palatial homes with bronze tripods and fur-lined beds rarely suffered. This results from Yin and Yang losing their positions, Cold and Heat occurring at wrong times, thus generating epidemics. Ignorant people hang talismans to suppress them, which is laughable.

*History of Yuan - Biography of Yelü Chucai*: Chucai followed the Great Khan to capture Lingwu. Generals fought for children, gold, and silk; Chucai alone took books and Rhubarb. Soon soldiers suffered epidemics; those who obtained Rhubarb recovered.

*Jiufeng Medical Cases*: On the second day, aversion to cold and fever, pain in head, body, waist, and back, white coating, red urine, no sweat, rapid pulse. Pathogen latent in Mo Yuan, emerging to the Taiyang Meridian. Notopterygium Root (1 qian), Saposhnikovia Root (1 qian), Ligusticum Chuanxiong (0.8 fen), Betel Nut (1 qian), Magnolia Bark (0.8 fen), Tsao-ko Kernel (0.5 fen), Wine-fried Scutellaria Root (1 qian), Prepared Licorice Root (0.5 fen), Red Peony Root (1.5 qian), Ginger (1 slice).